Clinical and Functional Outcomes of Platelet-Rich Plasma Injection and Corticosteroid Injection in Patients With De Quervain’s Tenosynovitis: A Comparative Retrospective Study

Background and aim De Quervain’s tenosynovitis (DQST) is a prevalent condition involving tendon inflammation in the wrist. This study compares the clinical and functional outcomes between patients receiving platelet-rich plasma (PRP) injections and those receiving corticosteroid injections for DQST. Methods A retrospective study conducted at Sri Devaraj Urs Academy of Higher Education and Research, Kolar, India, included 58 patients with DQST, divided into Group A (PRP injection) and Group B (corticosteroid injection). Assessments were conducted using the Visual Analogue Scale (VAS), the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and the Modified Mayo Wrist Score (MMWS) at baseline, one month, three months, and six months. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp., Armonk, NY, USA), with significance set at p < 0.05. Results Both treatment groups demonstrated a reduction in VAS scores over time. Significant improvements were observed at one month (p = 0.007) and six months (p = 0.004) post-injection. Baseline (p = 0.336) and three-month (p = 0.829) VAS scores showed no significant differences. Similarly, DASH scores were not significantly different at any measured time points: baseline (p = 0.331), one month (p = 0.592), three months (p = 0.707), and six months (p = 0.314). MMWS scores also showed no significant differences at baseline (p = 0.123), one month (p = 0.101), three months (p = 0.422), and six months (p = 0.956). Independent sample t-tests highlighted significant VAS score improvements at one month (t = 2.813, p = 0.007) and six months (t = -3.009, p = 0.004), but DASH and MMWS scores showed no significant differences at any time points. Chi-square tests indicated no significant associations between the groups at one-month, three-month, and six-month follow-ups. Conclusion Both PRP and corticosteroid injections effectively alleviate pain in DQST patients, as evidenced by significant VAS score improvements. However, functional outcomes measured by DASH and MMWS scores did not significantly differ between the treatments. These results suggest that while both treatments are effective for pain management, their short-term impact on functional improvement may be similar. To investigate long-term functional results, more research with bigger sample sizes and longer follow-up periods is required.


Introduction
Inflammation of the wrist tendons at the base of the thumb is known as de Quervain's tenosynovitis (DQST), and it primarily affects the abductor pollicis longus and extensor pollicis brevis in the first extensor compartment [1].It is often linked to repetitive or forceful manual tasks and pregnancy [2].According to epidemiological data, the prevalence of DQST peaks in the 40s and 50s, affecting approximately 0.5% of men and 1.3% of women [3].Patients usually report pain over the radial styloid process due to tendon friction in the narrowed compartment [4].Clinically, tenderness is noted on the radial side of the wrist, with symptoms exacerbated by the Finkelstein test [5].Nonoperative treatments [6], such as thumb spica splinting, nonsteroidal anti-inflammatory drugs, therapeutic exercises, and corticosteroid injection [7], are primary management strategies [8,9].Given DQST's impact on work and daily activities, it is crucial to evaluate the

Statistical analysis
A Microsoft Excel spreadsheet was used to enter the data (Microsoft Corporation, Redmond, WA, USA), and IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp., Armonk, NY, USA) was used for analysis.The chi-square test was used to determine the significance of the frequency and proportional presentations of the categorical data.The mean and standard deviation of continuous data were presented, and the mean differences between groups were ascertained using independent t-tests.Less than 0.05 was the threshold for statistical significance.

Results
A total of 58 participants were enrolled in the study, with each group consisting of 29 individuals.In the PRP injection group, 72.4% of the cases involved the right side, with a male proportion of 51.7% and a female proportion of 48.3%.In the corticosteroid injection group, 69.0% of the cases involved the right side, with 65.5% being males and 34.5% being females.The average age of participants was 43.3 years, with a standard deviation of ±8.6.
Table 1 displays the VAS, DASH, and MMWS scores for the group that received corticosteroid injections, measured at baseline, one month, three months, and six months after treatment.The initial VAS scores had an average of 6.69, which was reduced to 1.66 by the six-month mark.Similarly, the average DASH score dropped from 28.86 at baseline to 4.17 at six months.The MMWS scores improved significantly from a baseline mean of 64.86 to 87.38 at six months.These findings demonstrate substantial improvements in pain (VAS), disability (DASH), and wrist function (MMWS) over six months, highlighting the effectiveness of corticosteroid treatment in improving patient outcomes.Descriptive statistics for the VAS, DASH, and MMWS at baseline, one month, three months, and six months for both groups revealed a decrease in VAS scores over time, with significant improvements at one month (p = 0.007) and six months (p = 0.004).No significant differences were found in VAS scores at baseline (p = 0.336) and three months (p = 0.829).DASH scores did not differ significantly at any time points: baseline (p = 0.331), one month (p = 0.592), three months (p = 0.707), and six months (p = 0.314).Similarly, MMWS scores showed no significant differences at baseline (p = 0.123), one month (p = 0.101), three months (p = 0.422), and six months (p = 0.956).

Scores
Independent sample t-tests were used to compare the outcomes between the PRP and steroid groups, as shown in Table 3. Significant improvements in VAS scores were noted at one month (t = 2.813, p = 0.007) and six months (t = -3.009,p = 0.004).However, DASH and MMWS scores did not show significant differences at any time points, indicating that while pain reduction was achieved, functional improvements were not significantly different between the groups.

Discussion
The objective of the study was to compare the clinical and functional outcomes of PRP injections [17] versus corticosteroid injections in patients with DQST [18,19].The results indicate that both treatments are effective in reducing pain, as shown by significant improvements in VAS scores at one month and six months post-treatment [20].However, no significant differences were observed in functional outcomes as assessed by DASH and MMWS scores.

Pain reduction
Chi-square tests for the one-month, three-month, and six-month follow-ups revealed no significant associations, indicating no significant differences in these categorical outcomes between the treatment groups.
The notable reduction in VAS scores at one month (t = 2.813, p = 0.007) and six months (t = -3.009,p = 0.004) post-treatment underscores the effectiveness of both PRP and corticosteroid injections in reducing pain associated with DQST.This result is consistent with earlier research showing corticosteroids as an effective short-term solution for pain relief in DQST.For example, Lane et al. found that corticosteroid injections significantly alleviated pain within the first month of treatment, which supports our study's findings [3].Similarly, Ilyas observed significant pain reduction at six weeks post-treatment with corticosteroid injections, further affirming the short-term efficacy of corticosteroids [21].

Functional outcomes
Although significant pain relief was achieved, there were no notable differences in DASH and MMWS scores at baseline, one month, three months, and six months.This suggests that while both treatments are effective for pain management, they might not lead to substantial short-term improvements in functional outcomes.This observation is supported by a study by Peters-Veluthamaningal et al., which found that corticosteroid injections significantly reduced pain in DQST patients but did not significantly enhance functional outcomes compared to splinting alone [4].Additionally, Fitzpatrick et al.'s study indicated that corticosteroid injections alleviated pain but had a limited effect on short-term functional recovery [22].
The absence of significant differences in DASH and MMWS scores implies that while PRP may relieve pain, it might not offer additional functional benefits over corticosteroid injections in the short term.This finding is crucial for clinical decision-making, highlighting the need to consider patient-specific factors and preferences when selecting between PRP and corticosteroid injections for managing DQST.

TABLE 1 : Comparison of VAS, DASH score, and MMWS among the group that received corticosteroids
DASH, Disabilities of the Arm, Shoulder, and Hand; MMWS, Modified Mayo Wrist Score; VAS, Visual Analogue Scale

Table 2
presents data on VAS, DASH, and MMWS scores for patients treated with PRP at baseline, one month, three months, and six months post-treatment.The average baseline VAS score was 6.9, which was reduced to 1.14 by the six-month mark.The DASH scores started at an average of 27.93 and dropped to 3.66 after six months.The MMWS scores improved from a baseline mean of 62.62 to 87.45 at six months.These findings indicate significant improvements in pain (VAS), disability (DASH), and wrist function (MMWS) over six months, demonstrating the effectiveness of PRP treatment in improving patient outcomes.

TABLE 2 : Comparison of VAS, DASH score, and MMWS among the group that received PRP
DASH, Disabilities of the Arm, Shoulder, and Hand; MMWS, Modified Mayo Wrist Score; PRP, platelet-rich plasma; VAS, Visual Analogue Scale

TABLE 3 : Statistical analysis of VAS, DASH, and MMWS scores pre-and post-intervention
DASH, Disabilities of the Arm, Shoulder, and Hand; MMWS, Modified Mayo Wrist Score; VAS, Visual Analogue Scale